Kajiyama Shiro, Muroi Satoshi, Sugaya Hiroyuki, Takahashi Norimasa, Matsuki Keisuke, Kawai Nobuaki, Osaki Makoto
Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Japan.
Orthop J Sports Med. 2017 Mar 1;5(3):2325967117692513. doi: 10.1177/2325967117692513. eCollection 2017 Mar.
Osteochondritis dissecans (OCD) lesions are often observed in the humeral capitellum both in young baseball players and gymnasts. It is generally believed that capitellar OCD in baseball players can be seen on an anteroposterior (AP) radiograph with the elbow in 45° of flexion. However, the mechanism of injury seems to be different in baseball players and gymnasts. Repetitive valgus overload with the elbow in flexion is believed to be the cause of capitellar OCD lesions in baseball players, whereas weightbearing with the elbow in extension may be the cause of OCD in gymnasts.
To determine the difference in capitellar OCD location between baseball players and gymnasts and to propose the optimal AP radiographic angle of the elbow for visualization of early-stage OCD lesions in adolescent gymnasts.
Cross-sectional study; Level of evidence, 3.
Subjects consisted of 95 baseball players (95 elbows) and 21 gymnasts (24 elbows) with a mean age of 13.7 years (range, 11-18 years). To localize the lesion, inclination of the affected area in the humeral capitellum against the humeral axis was investigated using sagittal computed tomography images of the elbow. The inclination angle was defined as the angle between the long axis of the humerus and the line perpendicular to a line that connected the anterior and posterior margin of the lesion. The inclination angle in each group was compared and statistically analyzed.
The mean inclination angle was 57.6° ± 10.7° in baseball players and 28.0° ± 10.7° in gymnasts. Capitellar OCD lesions were located more anterior in baseball players when compared with gymnasts ( < .01).
Due to differences in applied stress, capitellar OCD lesions in baseball players were located more anteriorly compared with those seen in gymnasts. Therefore, although AP radiographs with the elbow in 45° of flexion are optimal for detecting OCD lesions in baseball players, radiographs with less elbow flexion or full extension are more useful in gymnasts, especially in early-stage OCD.
剥脱性骨软骨炎（OCD）病变在年轻棒球运动员和体操运动员的肱骨小头中经常可见。一般认为，棒球运动员的肱骨小头OCD在肘关节屈曲45°的前后位（AP）X线片上可见。然而，棒球运动员和体操运动员的损伤机制似乎有所不同。棒球运动员中，肘关节屈曲时反复的外翻超负荷被认为是肱骨小头OCD病变的原因，而体操运动员中，肘关节伸展时负重可能是OCD的原因。
确定棒球运动员和体操运动员肱骨小头OCD位置的差异，并提出用于观察青少年体操运动员早期OCD病变的最佳肘关节AP X线摄影角度。
横断面研究；证据等级，3级。
研究对象包括95名棒球运动员（95个肘关节）和21名体操运动员（24个肘关节），平均年龄13.7岁（范围11 - 18岁）。为了定位病变，使用肘关节的矢状面计算机断层扫描图像研究肱骨小头中病变区域相对于肱骨轴线的倾斜度。倾斜角定义为肱骨长轴与垂直于连接病变前后边缘的线的直线之间的角度。比较并统计分析每组的倾斜角。
棒球运动员的平均倾斜角为57.6°±10.7°，体操运动员为28.0°±10.7°。与体操运动员相比，棒球运动员的肱骨小头OCD病变位置更靠前（P <.01）。
由于施加应力的差异，与体操运动员相比，棒球运动员的肱骨小头OCD病变位置更靠前。因此，虽然肘关节屈曲45°的AP X线片最适合检测棒球运动员的OCD病变，但肘关节屈曲较少或完全伸展的X线片对体操运动员更有用，尤其是在早期OCD时。
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